Device programmer with enclosed imaging capability

ABSTRACT

Methods and electronic tools for imaging a chest region of a patient and communicating with a heart stimulation device used by the patient are disclosed. The electronic tool may include a communications device for two-way data transmission of signals encoded with information to and from the heart stimulation device. The tool may also include an imaging device for radiating energy onto the chest of the patient and receiving energy as it is reflected from the chest region to produce an image signal. The tool may include a display screen for showing an image of the chest area and/or the information received from the heart stimulation device. The tool may also include a processor for formulating and/or analyzing information sent to and/or received from the heart stimulation device. One method of using the electronic tool includes analyzing the image signal and/or received information to provide instructions to the heart stimulation device.

TECHNICAL FIELD

[0001] The present invention is directed to imaging systems andprogrammers for cardiac devices. More particularly, the presentinvention is directed to the combination of device programmers withimaging systems.

BACKGROUND

[0002] Cardiac devices, such as pacemakers and implantable cardiacdefibrillators, have electrical leads that must be implanted within oronto the surface of the heart. The electrical leads may be used todetect electrical events occurring in the heart and to pass anelectrical signal caused by the electrical event to the cardiac device.The electrical leads may also be used to provide electrical stimulationfrom the cardiac device to the heart tissue. The electrical stimulationcauses contraction of the heart tissue. For example, electricalstimulation can be provided to the heart to vary the delay between thedepolarization of the atrial area and depolarization of the ventriclearea.

[0003] To properly install the electrical leads of the cardiac device,sophisticated imaging systems such as fluoroscopy are typically used toprovide a high resolution X-ray of the patient's chest as the leads arebeing inserted. Generally, the sophisticated imaging systems arepermanently located in electrophysiology or surgical rooms, andimplantation of the device must occur at these locations.

[0004] In addition to the sophisticated imaging system, the physicianemploys a device programmer to adjust performance parameters of theimplantable device. The programmer generally uses telemetry to send andreceive signals, such as magnetic waves, to and from the implantabledevice. Thus, the physician uses the imaging system to view and positionthe electrical leads and to view the hemodynamic response of the heart.While viewing the leads and response, the physician also adjusts theoperational parameters of the device with the programmer to alter thehemodynamic response.

[0005] Therefore, there is a need for a tool that allows installation ofthe leads in a less rigorous medical environment while simplifying theevaluation and optimization of device performance.

SUMMARY

[0006] The present invention addresses problems such as but not limitedto those mentioned above by providing an electronic tool having aprogrammer system and an imaging system. A device programmer istypically portable and by combining an imaging system such as ultrasoundwith the programmer in the electronic tool, the implantation process maybe performed in environments other than surgical labs. Furthermore, thetool provides a display that may show an image of the patient's heartincluding the electrical leads while simultaneously showing ordinaryprogrammer information such as electrogram signals received from theimplantable device. The tool may also provide a processor to analyze theimage for lead position and hemodynamic response and may also analyzethe electrogram signals. From this analysis, the tool may communicatesignals to alter the device parameters and improve hemodynamic response.

[0007] The present invention may be viewed as an electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The tool includes an enclosure and an imagingdevice at least partially disposed within the enclosure. The imagingdevice radiates energy onto the chest region and detects energyreflected by the chest region to produce an image signal. The tool alsoincludes a communication device at least partially disposed within theenclosure that sends to or receives from the heart stimulation device afirst signal with encoded information.

[0008] The invention may be viewed as another electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The electronic tool includes an imaging device thatradiates energy onto the chest region and that detects energy reflectedby the chest region to produce an image signal. The tool includes acommunication device that sends to or receives from the heartstimulation device a first signal with encoded information. At least onedisplay screen is in electrical communication with the imaging deviceand the communication device, and the display screen displays arepresentation of the image signal or displays information from thefirst signal sent from or received by the communication device.

[0009] The present invention may be viewed as another electronic toolfor communicating with a heart stimulation device and for imaging achest region of a patient. The electronic tool includes an imagingdevice that radiates energy onto the chest region and that detectsenergy reflected by the chest region to produce an image signal. Thetool includes a communication device that receives a first signal withencoded information from the heart stimulation device. At least oneprocessing device is in electrical communication with the imaging deviceor the communication device, wherein the at least one processing deviceanalyzes the image signal or analyzes the information encoded on thefirst signal to formulate an instruction for the heart stimulationdevice.

[0010] The present invention may be viewed as another electronic toolfor communicating with a heart stimulation device and for imaging achest region of a patient. The tool includes means for radiating energyonto the chest region and for detecting energy reflected by the chestregion to produce an image signal. The tool includes means for radiatinga first signal with encoded information onto the heart stimulationdevice. The tool also includes means for formulating the first signalbased at least on the image signal.

[0011] The present invention may be viewed as a method of programming aheart stimulation device having one or more electrical leads placed in aheart of a patient. The method involves radiating energy onto an areaaround the heart of the patient and receiving energy reflected by theone or more electrical leads positioned in the heart. The method furtherinvolves producing an image signal representative of the received energyand analyzing, with a processing device, the image signal to measuremotion of the electrical lead. The method also involves producing, withthe processing device and in response to the measured motion of theelectrical lead, a signal encoding instructions for varying stimulationone or more stimulation parameters of the heart stimulation device.

[0012] The present invention may be viewed as a method for positioningan electrical lead of a heart stimulation device in a heart of apatient. The method involves radiating, with an imaging device at leastpartially within a first enclosure, energy onto an area around the heartof the patient and receiving energy reflected by the electrical leadpositioned in the heart. The method further involves producing an imagesignal representative of the received energy and involves receiving,with a communications device at least partially within the firstenclosure, an activity signal radiated from the heart stimulationdevice. The method also involves displaying, on a display screen, afirst representation of the image signal and a second representation ofthe activity signal.

[0013] The present invention may be viewed as an electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The electronic tool includes an imaging device thatradiates energy onto the chest region and that detects energy reflectedby the chest region to produce an image signal. The tool includes acommunication device that radiates a first signal with encodedinformation to the heart stimulation device. The tool also includes atleast one processing device in electrical communication with the imagingdevice and the communication device, wherein the at least one processingdevice analyzes the image signal to formulate an instruction for theheart stimulation device that is encoded onto the first signal.

[0014] The present invention may be viewed as a method of programming aheart stimulation device of a patient. The method involves radiating,with an imaging device, energy onto an area around the heart of thepatient and involves receiving, with the imaging device, energyreflected by the area around the heart. The method also involvesproducing, with the imaging device, an image signal representative ofthe received energy, and involves receiving a first signal radiated bythe heart stimulation device. The method further involves analyzing,with a processing device in electrical communication with the imagingdevice and the communications device, the first signal to measure aresponse of the heart. Additionally, the method involves producing, withthe processing device and in response to the measured response, a secondsignal encoding instructions for varying one or more stimulationparameters of the heart stimulation device.

DESCRIPTION OF THE DRAWINGS

[0015]FIG. 1 illustrates a block diagram of the components of oneembodiment of the present invention.

[0016]FIG. 2 shows an exterior of an electronic tool according to apreferred embodiment incorporating a display screen, keyboard, andstylus.

[0017]FIG. 3 depicts an exemplary operational flow of the processingsteps of one embodiment of the present invention.

[0018]FIG. 4 shows an exemplary operational flow of an optimization stepof the embodiment of FIG. 3.

[0019]FIG. 5 illustrates an exemplary operational flow of anotherpreferred embodiment.

[0020]FIG. 6 illustrates an exemplary screen display provided by oneembodiment.

DETAILED DESCRIPTION

[0021] Various embodiments of the present invention will be described indetail with reference to the drawings, wherein like reference numeralsrepresent like parts and assemblies through the several views. Referenceto various embodiments does not limit the scope of the invention, whichis limited only by the scope of the claims attached hereto.

[0022] Embodiments of the present invention include an electronic toolfor application to various activities such as electrical lead placementand implantable device optimization. Providing an imaging system with adevice communication system allows a single tool to obtain images of thelead position and the hemodynamic response as well as obtain datasignals indicative of the hemodynamic response while also communicatinginstructions to the implantable device to control its operation. Aprocessing system may be included within the tool to facilitateautomatic analysis and corresponding parameter optimization. A displaymay be included to facilitate user visualization of the lead positionand/or hemodynamic response. Including an input device within the toolallows the user to influence the instructions communicated to theimplantable device.

[0023]FIG. 1 shows a block diagram of an exemplary electronic tool 100incorporating programming and imaging functions. The tool 100 in thisexample includes an imaging device such as an ultrasoundtransmitter/receiver module 136 that sends and receives electricalsignals through line 134 to a phased array transducer 104. The phasedarray transducer 104 generates ultrasound energy waves 106 that radiateonto the chest of the patient having an implantable device 122. Theheart 102 of the patient may have several electrodes installed includingan atrial electrode 114, a right ventricle electrode 110, and a leftventricle electrode 112. These electrodes are electrically connected tothe implantable device 122 through leads 126, 128, and 130. Forembodiments where an ultrasound imaging device 136 is used, the leads126, 128, and 130 and the electrodes 110, 112, and 114 may be coatedwith an echogenic material that is opaque to ultrasound energy. Theultrasound imaging device may employ circuitry such as that known in theart for ultrasound imaging.

[0024] The transmitter/receiver module 136 is in electricalcommunication with a processor 146 through line 138. Thetransmitter/receiver module 136 passes an image signal created from thereception of ultrasound energy by the phased transducer array 104 to theprocessor 146. The image signal may contain digital data created by ananalog-to-digital conversion implemented by the transmitter/receivermodule 136. The processor 146 may then employ image processingtechniques to the image signal data to analyze various aspects of thesignal, as is discussed below. Alternatively, or in addition to feedingthe image signal to the processor 146, the transmitter/receiver module136 may feed the image signal directly to a display device 162 forreal-time display of a representation of the image signal.

[0025] The electronic tool 100 also includes a communications devicesuch as a telemetry module 140. Telemetry module 140 receives signalsfrom the processor 146 through line 144 and provides signals to theprocessor through line 142. Telemetry module 140 sends and receivessignals from a loop antenna 116, which typically is a wire loop. Theloop antenna 116 radiates electromagnetic energy in the form of a signal118. The signal 118 generally has encoded information such asinstructions for the implantable device 122 or trending data to bestored by the implantable device 122. The telemetry communicationsdevice 140 may use circuitry such as that known in the art forimplantable device communications.

[0026] The implantable device 122 receives the signal 118 from the loopantenna 116 and includes its own processing device for interpreting theencoded information and carrying out the instruction. Typically, theinstruction involves adjusting the timing of the stimulation pulseprovided to one of the electrodes in the heart 102. The implantabledevice 122 generally includes memory 124 such as for storinginstructions received from the loop antenna 116. The memory 124 may alsostore trending information, such as electrogram information that isrecorded by the implantable device 122 through the detection ofelectrical events by the electrodes 110, 112, and 114 in the heart 102.Other trending information that may be stored by memory 124 includes butis not limited to heart size and left ventricle septum-lateral wallsynchronization.

[0027] The implantable device 122 radiates a signal 120 that also hasencoded information, such as electrogram data being measured inreal-time by the electrodes 110, 112, and 114 or trending data that isstored by memory 124. The radiated signal 120 is received by the loopantenna 116 and is converted to an electrical signal that is transferredto the telemetry module 140. The telemetry module 140 may then employ ananalog-to-digital conversion to convert the received signal to a datasignal that is then passed to the processor 146. Alternatively, or inaddition to feeding received signals to the processor 146, the telemetrymodule 140 may feed signals directly to the display device 162 forreal-time display of the information encoded on the signal 120.

[0028] In an alternative embodiment, antenna 116 is of a type optimallyconfigured for transmitting and receiving RF signals. The RF antennaradiates electromagnetic energy in the form of an RF signal 118. Thesignal 118 generally has encoded information such as instructions forthe implantable device 122 or trending data to be stored by theimplantable device 122. In an embodiment utilizing RF data signals, thetelemetry communications device 140 may use basic RF base stationcircuitry such as that known in the art for a basic RF system.

[0029] The implantable device 122, which also includes RF circuitry thatallows the implantable device 122 to perform as a mobile RF terminal,has a communications link with the telemetry communications device 140via antenna 116. The implantable device 122 receives the signal 118 fromthe antenna 116 and includes its own processing device for interpretingthe encoded information and carrying out the instruction.

[0030] RF technology provides for wireless transmission of data bydigital radio signals at a particular frequency. It provides a means formaintaining bi-directional or two-way, online radio connection betweenthe telemetry communications device 140 and the implantable device 122.

[0031] The processor 146 may employ various operations, discussed inmore detail below with reference to FIGS. 3, 4, and 5 to utilize thesignals received from the imaging device 136 and/or the communicationsdevice 140. The processor 146 may store data to and access data fromstorage device 152, such as electronic memory or magnetic storage. Datais transferred to the storage device 152 through line 154, and data isreceived from the storage device 152 through line 156. The processor 146may be a general-purpose computer processor or processor typically usedfor a programmer. Furthermore as mentioned below, the processor 146, inaddition to being a general-purpose programmable processor, may befirmware, hard-wired logic, analog circuitry, other special purposecircuitry, or any combination thereof.

[0032] The processor 146 may also transfer a display signal to a displaydevice 162 through line 164. The display signal may include the imagesignal produced by the imaging device 136 as well as an informationsignal produced by communication device 140. The image signal componentfrom the imaging device 136 is typically an ultrasound image. Theinformation signal component from the communications device 140 istypically an electrogram. The display device 162 then displays on ascreen a representation of the ultrasound image and/or a representationof the electrogram, which can be seen in more detail with reference toFIG. 6 discussed below.

[0033] The electronic tool 100 may also include a printer 158 to producea paper copy of the display. The printer 158 receives the data signalfor the paper copy through line 160. An input device 148 may also beincluded with the electronic tool 100. The input device 148 may includeone or more various input interfaces, such as a keyboard, mouse, orstylus. The input device 148 communicates with the processor 146 throughline 150.

[0034]FIG. 2 shows an external view of the electronic tool 100 accordingto a preferred embodiment of the present invention. The tool 100includes the external transducer 104 for sending and receivingultrasound energy used for creating images. The tool 100 also includesan antenna 116 for sending and receiving modulated electromagneticsignals that may establish bi-directional communications with theimplantable device 122. The tool 100 that is shown includes an inputdevice 148 (see FIG. 1.) having both a keyboard 172 and a stylus 166that allow the user to input information such as function selections.The stylus 166 communicates with the input device module 148 throughline 168.

[0035] The electronic tool 100 also includes a display screen 170controlled by the display device 162. The display screen 170 may be aliquid crystal display (LCD) or other display type such as a cathode raytube (CRT). The display screen 170 may show various forms ofinformation, such as programmer menus, device parameter settings, theimage generated by the image device 136, and any information sent orreceived by the communications device 140.

[0036] The electronic tool 100 may be enclosed within a housing 174 madeof metal, plastic, or other rigid material. The keyboard 172 and displayscreen 170 may be integrated into the housing 174 such that theelectronic tool is enclosed within a single housing. Alternatively,multiple housings may be provided for various components, such asincluding a first housing for the display screen 170, a second housingfor the keyboard 174, a third housing for the processor 146, a fourthhousing for communications device 140, and a fifth housing for theimaging device 136.

[0037]FIG. 3 shows the operational flow 186 of the processing steps ofone embodiment whereby the operation of the heart stimulation device 122is optimized. The process begins by the processor 146 receiving an inputselection from a user at selection operation 176. The display screen 170may provide a user interface that allows the user to make selectionsfrom menus. A measurement menu may be provided to display the responsemeasurements that the user can select to optimize. These may include butare not limited to ejection fraction, stroke volume, end diastolicvolume, E/A (early wave/atrial kick) separation, cardiac output, andwall synchronization of the septum-lateral wall displacement. Using aninput device 148, the user then selects the desired measurement(s) tooptimize.

[0038] After receiving the measurement selection(s), the processor 146then configures the imaging device 136 to produce an image type thatcorresponds to the selected measurement(s) at configure operation 178.For example, if cardiac output or stroke volume is desired, theprocessor 146 may configure the imaging device 136 to produce an aorticflow image rather than an ordinary image of the heart. The operator thenplaces the transducer 104 over the aorta. If volume and ejectionfraction measurements are desired, the processor 146 may configure theimaging device 136 to produce a ventricular cross-section image, and theoperator places the transducer 104 over the ventricle. If a fillingprofile measurement is desired, the processor 146 may configure theimaging device 136 to produce a mitral flow image, and the operatorplaces the transducer 104 over the mitral valve.

[0039] Once the imaging device 136 has been properly configured, theprocessor 146 may then receive a selection from the user from a menu ofdevice parameters that may be varied to alter the chosen measurement.The parameters may include but are not limited to the atrial-ventricular(A/V) delay, the lower rate limit, the sensed A/V offset, the maximumsensor rate, the maximum tracking rate, and the right ventricle-leftventricle delay. For certain parameters, processor 146 may accept rangesentered by the user, such as an upper and lower limit to theatrial-ventricular (A/V) delay. By this point, the imaging device 136may be providing the appropriate image signal to the processor 146,which then extracts the measurement(s) from the image signal anddisplays the measurement(s) on the display screen 170. A representationof the image signal itself may also be displayed so the operator mayvisualize the response of the heart.

[0040] After the desired parameter and corresponding range have beenentered, the processor 146 begins to optimize the measurement(s) atoptimize operation 182 by varying the chosen parameter within the rangeby communicating instructions to the heart stimulation device 122. Theoptimization process is discussed in more detail below with reference toFIG. 4. Once the measurement(s) taken from the image signal reaches theoptimum value, the optimization process terminates and the current valueof the parameter(s) is taken to be the optimal value for the chosenmeasurement(s). The processor 146 may make other measurements at thisoperation as well, such as those to be stored by the tool 100 or theheart stimulation device 122 for trending purposes includingmeasurements such as heart size that cannot be altered through deviceparameter manipulation.

[0041] The processor 146 then programs the heart stimulation device 122with the optimal value(s) for the parameter(s) at program operation 184.The processor passes the programming instruction including theparameter(s) and optimal value(s) to the heart stimulation device 122through a telemetered signal provided by the communications device 140.The program operation 184 may also involve the processor 146 sending aprogramming instruction including a measurement, such as the previouslyselected measurement or another, that is to be stored in the memory 124of the processing device so that it can be retrieved by the electronictool 100 at a later date for trending purposes.

[0042] As discussed above, FIG. 4 shows the optimization step 182 ingreater detail. The optimization step 182 begins by the processor 146receiving the image signal taken from the imaging device 136 at imageoperation 188. At this point, the processor 146 may also be streamingthe image signal to the display device 162 for display on the displayscreen 170, or the image device 136 may provide the image signal to thedisplay device 162 directly.

[0043] The processor 146 then processes the data of the image signal atprocess operation 190 to make the selected measurement(s) by using imageprocessing techniques known in the art. For example, the processor 146may measure the velocity from the aortic flow image and integrate thevelocity with respect to time when determining cardiac output. Inanother example, to measure lateral wall displacement, the processor 146may detect and measure motion of an echogenic lead located on thelateral wall. Once the measurement(s) are obtained, the measuredvalue(s) are compared to an optimum value(s) at compare operation 192.In the lateral wall displacement example, the optimum value may be athreshold displacement that must be reached or exceeded to be optimal.The optimum value for each measurement may be one that is stored inmemory 152 of the tool 100 or one that is specified by the user whenselecting the tool at selection operation 176 of FIG. 3.

[0044] After the comparison has occurred, query operation 194 detectswhether the measurement(s) equal the optimum value(s), or exceeds it inthe case of some measurements such as lateral wall displacement. If so,then the optimization operation 182 reaches stop operation 198 andoperation proceeds to program operation 184 of FIG. 3. If queryoperation 194 detects that the measurement(s) are not equal to theoptimum value(s) or is some cases whether the measurement is less thanthe optimum value, then parameter operation 196 triggers the processor146 to generate an instruction that alters the parameter value(s) withinthe heart stimulation device 122 by sending the instruction through asignal provided by communications device 140.

[0045] After allowing for the heart stimulation device 122 to implementthe new parameter value(s) and allowing the patient's heart 102 torespond to the change, receive operation 188 again retrieves an imagesignal containing the data showing the heart's response to the change.The optimization process 182 then repeats continuously until themeasurement(s) equal the optimum value(s). Finding that themeasurement(s) do equal, or is some cases exceeds, the optimum value(s)may require determining whether the measurement(s) lie within apermissible tolerance range centered about the optimum value(s).

[0046]FIG. 5 shows another process that may be implemented using thetool 100. This process 200 involves placing leads of the heartstimulation device 122 within the heart 102 of the patient. This process200 begins by the processor 146 retrieving the image signal from theimaging device 136 at image operation 202. For determining leadplacement, the image signal will typically be an actual picture of theheart 102. The processor 146 retrieves a data signal from thecommunications device 140 at data operation 204. The data signal may bean intracardiac electrogram signal, a pacing impedance signal, or otherdevice/lead parameter signals that are useful in optimizing the leadposition.

[0047] At representation operation 206, a representation of the imagesignal (i.e., an actual picture of the heart) is displayed on thedisplay screen 170, which also displays a representation of the datasignal (i.e., an electrogram, etc.). Displaying both the representationof the image signal and the representation of the data signal permitsthe user to see both the electrical and mechanical responses of theheart 102 and permits the delay between the two to be observed. Theprocess continues to query operation 208, which detects whether the leadis in a proper position. The query operation 208 may function byprompting the user to indicate through the input device 148 that thelead has reached a proper location. Alternatively, the processor 146 mayanalyze the data signal to determine whether the lead has a properlocation based on various measurements of heart activity. If noindication of proper location is detected, operation returns to receiveoperation 202 where the procedure is repeated.

[0048] Once query operation 208 finds that the lead is in a properlocation, the processor 146 analyzes the data signal to find optimalparameter settings at analyze operation 207. For example, the processor146 may determine the natural A/V delay from the data signal by usingthe lead as a sensor to detect intrinsic heart activity. From thisanalysis, the processor 146 can determine optimal parameter settings.After completing the analysis, the processor 146 formulates aninstruction including the optimal parameter settings that are thentransmitted to the heart stimulation device 122 with the communicationsdevice 140 at program operation 209.

[0049]FIG. 6 shows an example of the contents 210 of display screen 170of the electronic tool 100. The contents 210 of this embodiment includea menu area 212 that includes measurement selections 214 and parameterselections 218. Also, measurement area 216 is included to show thecurrent measurement value, and parameter area 220 is included to receiveand show the current parameter range. As shown, the selected measurementis cardiac output and it has a current measured value of 5.1 liters perminute. The selected parameter is A/V delay and the designated range isfrom 30 to 200 milliseconds

[0050] The contents 210 of the screen 170 also include an image area 222for displaying a representation of the image signal, such as displayingan actual picture of the heart or an image of flow. As shown, an imageof flow through the mitral valve is being displayed in the image area222. The display may also include an external cardiac signal area 224for displaying a representation of a data signal, such as an external orsurface electrocardiogram. The external electrocardiogram signal mayoriginate from an EKG machine that feeds an output signal into an analoginput port forming part of input device 148 (See FIG. 1). The analoginput port may then direct the output signal to the display device 162.Alternatively, the EKG functionality could be included as part of thefunctionality of the tool 100.

[0051] The contents 210 of the display screen 170 also include anintracardiac signal area 226. This area is for displaying arepresentation, such as an intracardiac electrogram, of a data signalreceived by the communications device 140 from the heart stimulationdevice 122. Supplemental image area 228 is also included in the displayscreen 170 to show an actual but limited image of image of the heart toindicate to the user where the transducer 104 is located relative to theheart 102. The supplemental image area 228 is useful when a flow imageis to be used and the user must position the transducer 104 over theaorta or a particular valve where flow is to be measured.

[0052] The embodiments of the operations of the invention, such as butnot limited to those of FIGS. 3, 4, and 5 are implemented as logicaloperations in the system. The logical operations are implemented (1) asa sequence of computer implemented steps running on a computer system ofthe electronic tool comprising a processing module such as processor 146and/or (2) as interconnected machine modules running within thecomputing system.

[0053] This implementation is a matter of choice dependent on theperformance requirements of the computing system implementing theinvention. Accordingly, the logical operations making up the embodimentsof the invention described herein are referred to as operations, steps,or modules. It will be recognized by one of ordinary skill in the artthat the operations, steps, and modules may be implemented in software,in firmware, in special purpose digital logic, analog circuits, and anycombination thereof without deviating from the spirit and scope of thepresent invention as recited within the claims attached hereto.

[0054] While the invention has been particularly shown and describedwith reference to preferred embodiments thereof, it will be understoodby those skilled in the art that various other changes in the form anddetails may be made therein without departing from the spirit and scopeof the invention.

What is claimed is:
 1. An electronic tool for communicating with a heartstimulation device and for imaging a chest region of a patient, theelectronic tool comprising: an imaging device that radiates energy ontothe chest region and that detects energy reflected by the chest regionto produce an image signal; a communication device that receives a firstsignal with encoded information from the heart stimulation device; andat least one processing device in electrical communication with theimaging device and the communication device, wherein the at least oneprocessing device analyzes the image signal or analyzes the informationencoded on the first signal to formulate an instruction for the heartstimulation device.
 2. The electronic tool of claim 1, furthercomprising: a display screen that is communicatively linked to theimaging device and that displays a representation of the image signal ora representation of the encoded signals .
 3. The electronic tool ofclaim 1, wherein the processor communicates with the imaging device toanalyze the image signal and formulate a first signal that is sent tothe heart stimulation device.
 4. The electronic tool of claim 1, whereinthe encoded signals include a first signal that is received from theheart stimulation device by the communication device, the processor thatcommunicates with the communication device is configured to analyze thefirst signal and to formulate a second signal, wherein the communicationdevice sends the second signal to the heart stimulation device.
 5. Theelectronic tool of claim 1, further comprising: at least one displayscreen in electrical communication with the imaging device and thecommunication device, wherein the at least one display screen displays arepresentation of the image signal or displays information from thefirst signal sent from or received by the communication device.
 6. Theelectronic tool of claim 1, wherein the first signal is sent by thecommunications device, the electronic tool further comprising: an inputdevice for receiving input information from a user, wherein the at leastone processing device analyzes the information received by the inputdevice to formulate the information encoded on the first signal.
 7. Theelectronic tool of claim 1, wherein the imaging device comprises anultrasound transducer array that radiates and receives ultrasoundenergy.
 8. The electronic tool of claim 1, wherein the communicationsdevice comprises a wire loop that radiates and receives magneticsignals.
 9. The electronic tool of claim 1, wherein the communicationsdevice includes an RF antenna that transmits and receives RF signals.10. The electronic tool of claim 1, wherein the heart stimulation devicehas electrical leads located in the patient's chest area that reflectenergy radiated by the imaging device and wherein the imaging devicedetects the energy reflected by the electrical leads to produce an imagesignal that causes the electrical leads to appear on the display screen.11. An electronic tool for communicating with a heart stimulation deviceand for imaging a chest region of a patient, the electronic toolcomprising: means for generating an image of the chest region; meanstransmitting information to the heart stimulation device.
 12. Theelectronic tool of claim 11, wherein the means for generating an imagecomprises a display screen for providing a representation of an imagesignal to a user and an input device for receiving information input bya user that is encoded onto the first signal.
 13. The electronic tool ofclaim 11, wherein the means for transmitting encoded informationtransmits encoded information as an RF signal.
 14. The electronic toolof claim 11, wherein the means for transmitting information comprises ameans for bidirectional communication of RF signals.
 15. A method ofprogramming a heart stimulation device of a patient, the methodcomprising the steps of: generating, with an imaging device, an imagesignal representative of an image of an area around the heart; receivinga first signal transmitted by the heart stimulation device; analyzing,with a processing device in electrical communication with the imagingdevice and a communications device, the first signal to measure aresponse of the heart; and producing, with the processing device and inresponse to the measured response, a second signal encoding instructionsfor varying one or more stimulation parameters of the heart stimulationdevice.
 16. The method of claim 15, further comprising a step ofcommunicating the second signal to the heart stimulation device.
 17. Themethod of claim 15, further comprising a step of displaying arepresentation of the image signal and a representation of the firstsignal on a display screen.
 18. The method of claim 15, furthercomprising a step of positioning leads of the heart stimulation devicewithin the heart, wherein the image signal and the response extractedfrom the first signal indicate the position of the leads, and whereinthe instructions encoded by the second signal are based upon theposition of the leads.